Flashcards in Emergency Medicine Deck (51)
Typical antipsychotics: side effects and risks?
Neuroleptic malignant syndrome. Sx: EPS, sweating, tachycardia, muscle rigidity, hyperthermia. Typical > atypical. Tx: bromocriptine and dantroline, diazepam
How do you treat a benzodiazepam overdose?
flumenazil 200ug c 1-2minutes. Max 3mg/hour. MOA: GABA antagonist.
Difference between megaloblastic anemia due to folate deficiency or B12 deficiency?
B12 deficiency will cause neurological symptoms; folate deficiency will not
Most common infection in burn victims?
Normal urine output/hr
30cc stable patient; 50cc in a trauma patient
Symptoms of increased ICP?
Cushing reflex: bradycardia, hypertension, abnormal breathing
Also fixed & dilated pupils, vomiting, papilledema
tx: IV mannitol
Tx for cardiogenic shock?
Dobutamine (beta-1 agonist)
Tx for malignant hyperthermia?
Dantroline (muscle relaxer; decreases excitation coupling by acting as an antagonist on the ryanodine receptor, decreasing intracellular Ca+ concentration)
Sx of cardiac tamponade?
Pulsus paradoxus; Beck's triad (increased JVP, hypotension, decreased heart sounds)
Difference between subdural and epidural hematoma on CT?
Subdural: cresent-shape lesion on CT, blown pupil
Epidural: Biconvex (diamond-oval), blown pupil
Recall that dura mater -> arachnoid -> pia mater, from outside to inside
How to differentiate between hemothorax and pneumothorax with percussion?
What is the definition of hemodynamic instability in a trauma patient?
To estimate SBP without a sphygmomanometer:
If a trauma patient is stabilized and then becomes suddenly unstable, what is at the top of your ddx?
tx: have them lie in LLD, give oxygen, ER
If a pt with chest trauma suddenly has a new diastolic murmur and hoarseness, what do you suspect?
hoarseness is caused by impingement on the recurrent laryngeal nerve
risks for dissection include EDS, Marfan's, and syphilis
aortic disruption can be caused by breaks in the 1st rib, scapula, sternum; these are strong bones and are very hard to break. if a pt comes in with any of these bones broken, suspect internal injuries
All patient w LOC get what imaging done?
CT head w/o contrast
Symptoms of a fat embolism?
patient with a long-bone fracture suddenly has fever, tachycardia, tachypnea, conjunctival hemorrhage and petechiae
What is a flail chest?
3+ ribs broken in at least 2 places so pieces of the bone are not connected to any of the rest of the ribs
In blunt abdominal trauma, what is the most common injury?
#1 injury to the spleen
If the injury is handlebar trauma in a child, most common is pancreas injury, then duodenum (sx of this include epigastric pain with bilious vomiting)
Most common site of diaphragm rupture?
L side (liver protects R)
Acute abdomen lesser-known ddx
Main categories: perforation, obstruction, inflammation, ischemia
sickle cell anemia crisis, porphyria, DKA, leukemia, pneumonia, lead poisoning, black widow bite
+bHCG in a shock patient is what?
ruptured ectopic pregnancy until proven otherwise
Acute abdomen with blood pr is what?
mesenteric ischemia until proven otherwise
usually elderly, history of AAA or Afib, or **cocaine user
Risks for biliary colic?
4 Fs (female, fat, forty, fertile)
Ischemic colitis is most common in who?
patient with a history of MI, stroke, or CAD (other blood vessel disease predisposes)
When is abdominal CT with contrast indicated?
appy, IBD, diverticulitis, AAA, cancer
PAIN (pain relief, antibiotics, IV fluids, NPO)
Abx need to have both anaerobic and Gm(-) coverage i.e.
cefazoline + metronidazole
cefazoline is bactericidal: it binds certain proteins and causes bacteria to lyse because they break down their own walls
metronidazole is a nitroimidazole and is also bactericidal. it disrupts DNA synthesis.
Difference in appearance between 1, 2, and 3 degree burns?
1: only epidermis. epidermis is red and intact, no blisters (i.e. sunburn)
2: extends into dermis. painful blisters (i.e. boiling water)
3: painless, white, charred (i.e. fire)
In any burn involving a fire: assess for smoke inhalation (CO risk) or exposure to burning textiles (CN- risk)
What are the causes of PEA?
5Hs & 5Ts
hydrogen ions (acidosis)
tablets (drug OD)
thrombosis (pulmonary embolism)
tx: CPR, epinephrine, +/- vasopressin (if due to hypovolemia), find cause from list above and tx the cause
DO NOT DEFIB A PT IN PEA/ASYSTOLE
let the AED decide, but it will probably opt not to
proceed with CPR anyway and hopefully this will bring back a rhythm
What is the first symptom of hemorrhagic shock?
changes in heart rate. blood pressure will not change until >1.5L of blood has been lost